Provider Demographics
NPI:1871242347
Name:DR GOMEZ CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:DR GOMEZ CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:HUGO
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-916-0407
Mailing Address - Street 1:13911 N DALE MABRY HWY STE 107
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2414
Mailing Address - Country:US
Mailing Address - Phone:727-916-0407
Mailing Address - Fax:813-242-3412
Practice Address - Street 1:13911 N DALE MABRY HWY STE 107
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2414
Practice Address - Country:US
Practice Address - Phone:727-916-0407
Practice Address - Fax:813-242-3412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty